The practical utility of routine postpartum hemoglobin assessment

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Abstract

OBJECTIVE:

To evaluate a policy of routine versus selective postpartum complete blood count (CBC).

STUDY DESIGN:

Historic case control design with matched subjects from 1 year periods bracketing the policy change (n = 800). Our primary outcome was postpartum transfusion rate. Univariable and multivariable analyses were performed. Total hospital costs were estimated.

RESULTS:

Eliminating routine postpartum CBC testing was associated with decreased transfusion rates (5.5% vs 1.8%, P = .007) despite similar transfusion risks. CBC utilization decreased from 59% to 22.2% (P < .0001). No adverse bleeding outcomes occurred. Multivariable modeling suggested that the occurrence of postpartum hemorrhage was the best clinical predictors of transfusion n risk. Tachycardia, oliguria, and symptoms were also effective at identifying transfusion candidates. Elimination of routine CBC was independently associated with a reduced risk of transfusion (odds ratio, 0.30; 95% confidence interval, 0.12–0.72). Annual cost savings were estimated at $58,000.

CONCLUSION:

Targeted CBC testing results in fewer transfusions, lower costs and improved quality of patient care.

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